Strong and clearly defined business and financial incentives are required to address challenges and barriers to the electronic exchange of health information, which continue to dog the healthcare industry as it begins delivery system reform and a move towards value-based payment.

That’s the conclusion of a new report to Congress from the Health Information Technology Policy Committee, a federal advisory committee to the Office of the National Coordinator for Health IT.

“Certifying or applying incentives to specific components of interoperability has not been effective at engaging and activating the required stakeholders,” concludes the report developed by a HIT Policy Committee task force and required by the Consolidated and Further Continuing Appropriations Act of 2015.

A key inhibitor of health information exchange has been “economic incentives that, at best, have not encouraged, and at worst, have even discouraged, sharing of clinical information among providers (e.g., information blocking),” according to ONC. In addition, the agency reported to Congress that “traditional fee-for-service payment models (which currently still dominate most American healthcare markets) do not create incentives for providers to make health information exchange processes and technologies a higher priority among the many priorities that they manage on a daily basis.”

As the report points out to lawmakers, interoperability and effective health information exchange are crucial to achieving value-based care delivery under the new payment models, which may motivate a health system to exchange data internally but additional incentives are necessary to promote widespread HIE with organizations external to a provider’s health system. “The long-standing fee-for-service reimbursement model creates a perverse incentive to ignore information from other sources.”

To address these and other challenges, ONC makes four new recommendations that specifically target financial and business barriers to interoperability that the agency believes could begin to be acted upon in the next six months and will accelerate the pace of progress:

  • Develop and implement meaningful measures of HIE-sensitive health outcomes and resource use for public reporting and payment;
  • Develop and implement HIE-sensitive vendor performance measures for certification and public reporting;
  • Set specific HIE-sensitive payment incentives that incorporate specific performance measure criteria and a timeline for implementation that establishes clear objectives of what must be accomplished under alternative payment models, and;
  • Convene a working summit of major stakeholders co-led by the federal government (e.g., ONC, CMS) and the private sector to act on the ONC Interoperability Roadmap to accelerate the pace of progress towards interoperability.

 ONC also highlighted the problem of electronic health information blocking. “While we lack quantitative data about the extent of the problem, reports of information blocking have raised significant concern,” states the report. “In the end, it will be essential to change the culture of healthcare to one that incentivizes information sharing. The key is to accelerate the transition from fragmented fee-for-service care to one that supports coordinated, individual- and family-centered, high value care, and to provide the tools, resources, and incentives to perform effectively in an interdependent, complex ecosystem.”
Also See: Data Blocking Hampers Interoperability, ONC Says

Responses to ONC’s interoperability report to Congress were positive. John Halamka, M.D., CIO of Boston’s Beth Israel Deaconess Medical Center, praised the report for being “very well written” and recognizing that health information exchange is a combination of technology, policy, and incentives.  

“Once we have enabling infrastructure like provider directories, person identifiers, and record locator services, then EHRs will be able to connect more fluidly,” says Halamka. “Once state privacy and consent laws are easier to navigate then patients will be able control flows of information. Once clinicians are reimbursed for wellness and care coordination, information will flow. The report does not suggest overly simplistic solutions like ‘penalties for information blocking’. I applaud the work.”

The Health IT Now Coalition, which includes patient groups, provider organizations, employers and payers, issued a written statement agreeing with the agency’s assertion that a lack of widespread interoperability will greatly hinder coordinated patient care. And, “despite recent claims to the contrary, we also agree that information blocking is a crucial and real issue that is harming providers and patients, and commend ONC for calling for actions to end information blocking,” said the statement.

Nonetheless, Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, who served on the HIT Policy Committee task force that developed ONC’s report to Congress, believes that “information blocking—malicious denial of exchange for competitive reasons—is an isolated and rare phenomenon and is not a major barrier to widespread interoperability.”

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